Artikel asli

Breast cancer and psychological resilience among young women

D. Di Giacomo 1, K. Cannita 2, J. Ranieri 1, V. Cocciolone 2, D. Passafiume 1, C. Ficorella 2 3

1  Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy; 2  San Salvatore Hospital, Medical Oncology Division, L’Aquila, Italy; 3 Department of
Biotechnological and Applied Clinical Study, University of L’Aquila, Italy

Ringkasan pression of the anxiety scores highlighted resilient performance in breast

tujuan
Tujuan dari penelitian ini adalah untuk menguji ketahanan psikologis di kalangan
wanita muda setelah diagnosis kanker payudara, karena mereka dapat dianggap
sebagai kelompok risiko tekanan psikologis untuk peristiwa klinis.
cancer patients. Moreover, interesting to notice that the MANOVA analysis
comparing the psychological tests in differ- ent time of the treatment (T0 = post
survey; T1 = post chemo- therapy and T2  =  ongoing hormone therapy) hasn’t
showed significant differences between emotional condition of patients and
health subjects.

Conclusions
Bahan dan metode
Our results highlighted the psychological resilience in young women that have
Sebuah sampel n. 82 perempuan di rentang usia tua 31-51 tahun direkrut dan
to deal with the breast cancer diagnosis and treatment. Our finding showed
didistribusikan dalam 2 kelompok: kelompok) Kanker Payudara:
that young patients seem more emotional resilient: experiencing negative
n. 42 wanita didiagnosis dan b) kelompok normal Control:
emotions and trans- forming that in personal growth; young patients can be
n. 40 wanita sehat. Baterai psikologis terdiri dari tes laporan diri: PDI, STAXI,
consid- ered a target to support with specific treatment to improve their
TINGGAL dan BDI-II.
wellness and quality of life after overcoming physical weakness.

hasil
Our results evidenced significant impact only in depression scale: the patients
Key words
presented higher scores than control group. The experience, expression and
control of the anger and the ex- Resilience • Psychological distress • Breast cancer • Young women

Introduction between ‘Ambivalence over Emotional Expression’ (AEE = conflict

between waiting to express yet fearing the consequences of such
The breast cancer diagnosis and related clinical treatment have a
expression) and depression symptoms in breast cancer survivors.
strong impact on the women emotional system and quality of life.
Women showed higher depressive symptoms risk if having also high
Several studies have detected the negative effect of cancer diagnosis
AEE factor, and that might be joined cognitive mechanisms as
on affective relations, life expectation, long time planning, productivity,
intrusive thought (=  repetitive and unwanted thoughts about stressful
sociality; psychological signs of mental weakness could be depression,
events  6).
anxiety, anger, low mood, social retraction, isolation, aggressivity.
Primary impact is on woman patient; secondary effect is
A protective factor for stressing in clinical setting might be the
simultaneously on her family, such as in social and working
environment. Linley  1 sustained that the 60% the patients refers psychological resilience, or better the positive adjustment outcomes to

stressful condition and psychological weakness. According to several the exposure of adversity  7.
researches, the cancer experience is distressing and disruptive, but Recently, clinical practice showed the cancer patients have a good
the clinical practice suggested that the outcomes could assume also level of resilience to the disease impact and that is linked much more
positive aspects in terms of personal resources, enhanced sense of to a major compliance level in the treatment protocol. Some
purpose  2 3. Bellizzi  4 reported growing personal experiences dealing with researchers showed that the processes of resilience and experience
illness in terms of improved social relationship, changing in life priority. of growth are associated with better adaptation psycho-physiological
Lu  5 examined an interesting construct about the link post-event and lower levels of psychological distress in the medium
and long term  8 9.

Studies highlighted the importance could have the resilience for the
compliance of patients with breast cancer

Korespondensi
Dina Di Giacomo, Departemen Hidup, Kesehatan dan Ilmu Lingkungan, Universitas L'Aquila, Italia • E-mail: dina.digiacomo@cc.univaq.it

Jurnal Psikopatologi 2016; 22: 191-195 191

D. Di Giacomo et al.
diagnosa  10-13. Pokoknya dalam literatur kanker, beberapa temuan terjadi
manfaat atau hasil positif pada wanita minoritas tetapi dengan bukti-bukti
tidak jelas. Di add, beberapa penelitian dilakukan sejauh sampel di
rentang usia anak usia 50-70 tahun. Tujuan keseluruhan dari penelitian ini
adalah untuk menyelidiki kondisi emosional dibatasi untuk pasien kanker
payudara yang ditargetkan. kepentingan kita difokuskan pada rentang
usia yang lebih muda untuk menyelidiki fitur emosional diaktifkan pada
wanita muda dengan diagnosis kanker payudara, dan hubungan dengan
tekanan psikologis. Kami memeriksa kondisi emosional perempuan
selama pengobatan farmakologis mereka untuk memverifikasi risiko dan
faktor pelindung menganalisis karakteristik perilaku dan ada / tidaknya
ketahanan psikologis pada wanita kanker payudara.
Bahan dan metode
subyek
The sample was composed of n.  82 women in range age 31-51  Ini adalah kuesioner self-diadministrasikan yang itu mau mengukur
years old (mean age 42.2, sd ±  4.1) distributed in two groups: a)
Breast Cancer (BC) group: the BC group was composed of 42 women
(mean age 42.6, sd ± 3.6) and b) Normal Control (NC) group: the NC
group was composed of n. 40 healthy women (mean age 41.7, sd
± 4.6). The BC group was recruited in San Salvatore Hospital  –
Medical Oncology Division (Director: Prof. Ficorella, L’Aquila, Italy),
while the NC group was composed of healthy volunteers without
clinical signs and/ or psychological symptoms. Informed written
consensus was obtained for each participant.
In Table I are reported demographical data about sample.
Measures
Data on sociodemographic, medical and psychological variables were
collected to investigate the relationships between psychological
conditions and dealing with breast cancer treatment.
Sociodemographic variables: sociodemographic variables have been:
age, marital status, maternity, level of education, employment status.
TaBle I.
Demographic data of sample.
BC group
Variables
X sd
Age 43.4 ± 4.0
Education 13.2 ± 3.1
Children 1.3 ± 0.8
Married
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Medical variables: medical variables were abstracted from patient’s
charts: cancer stage, type of surgery, chemotherapy status, hormone
therapy status.
Psychological variables: the measured psychological variables have
been: depression, anger, anxiety, psychological distress.
Psychological Tests
sampel diserahkan ke baterai psikologis terdiri dari kuesioner
psikologis, tercantum di bawah ini:
• Distress psikologis Persediaan ( PDI)  11. Ini adalah kuesioner
selfadministrated menyetujui untuk mengukur dampak dari
penyakit dan terapi dalam hal tekanan psikologis. Hal ini terdiri
dari 13 pertanyaan dan jawaban pada skala Likert (5 poin). The
persetujuan skor standar untuk Estime kehadiran / adanya
tekanan psikologis untuk mengukur tertekan global. Tes ini
disampaikan satunya kelompok pasien;
• keandalan internal yang baik (a = 0,86);
• Negara-Trait Anger Ekspresi Inventarisasi-2 ( STAXI-2)  12.
keadaan emosional dan ciri-ciri kepribadian; di particolar, ciri-ciri
dievaluasi adalah pengalaman, ekspresi dan kontrol kemarahan. The
persetujuan scoring untuk releave sifat yang berbeda dari personaliy
risiko kemarahan. Keandalan internal a = 0,83 untuk kelompok pasien
dan a = 0,61 untuk kelompok kontrol;
• Stait-Trait Anxiety Inventory-Form Y ( TINGGAL) 13. Hal ini self-laporan tes
untuk mengukur keadaan dan sifat kecemasan. Hal ini terdiri dari 40 item.
scoring adalah atas dasar prosedur standar. Keandalan internal a = 0,62
untuk kelompok pasien dan a = 0,73 untuk kelompok kontrol;
• Beck Depression Inventory-II ( BDI-II)  14. Ini adalah tes diri
diadministrasikan. BDI-II terdiri dari 21 item untuk menilai intensitas
depresi pada pasien klinis dan normal. Setiap item adalah daftar
empat pernyataan diatur dalam meningkatkan keparahan tentang
suatu gejala tertentu depresi. The persetujuan scoring untuk
releave ada / tidaknya depresi dan derajat terkait (dari minimal
untuk tanda depresi berat). Keandalan internal yang baik untuk
kedua pasien (a = 0,81) dan kontrol (a = 0,76) kelompok.
NC group
p F
X sd
42.4 ± 3.7 0.24 1.35
16.5 ± 0.8 0.00 40.64
1.2 ± 0.8 0.56 0.34
 Breast cancer and psychological resilience among young women

Procedure Tabel II.

skor mentah dari kinerja sampel.
The psychological evaluation of BC group was conducted in quite room
allowed in Medical Oncology Division of San Salvatore Hospital in kelompok BC kelompok NC
variabel F p
L’Aquila (IT). The NC was examined in Psychological Laboratory of X sd X sd
University of L’Aquila (IT). Trained psychologists have applied the STAXI
evaluation protocol. All tests have been administred to BC group, while Negara 14,9 10.9 11.4 0,001
only STAXI, BDI and STAI to NC group. Every evaluation session Kemarahan Trait 18.4 19,7 1,72 0,192
lasted 1 hour and has been distinguished in two steps: clinical interview Anger Axe keluar / 18.3 19,8 3,27 0,074
and testing. During the interview time has been conducted the clinical Axe / Con Axe / Ex 22,3 22,3 3.36 0,071
Jumlah Skor 27,7 27,7 0,13 0,718
evaluation and during the testing time tests have been administrated.
127,4 ± 5,921,5
±±7,4
4,0 ±±
4,54,0
± 130,3 ± 1,69,7
±±6,4
3,3 ±±
4,05,0
± 0.60 0,43
Blended judges have codified the psychological tests.
STAI
Skor total 89,7 ± 5,8 89,0 ± 7,4 0,233 0,631 BDI

Skor total 9,6 ± 7,2 6,5 ± 4,8 5,13 0,026

Ethic Committee
PDI
Positive Opinion was obtained by Ethic Committee form University of Skor total 29,9 ± 8,4
L’Aquila (IT).

Statistical Analysis
BC group; we compared the psychological status (evaluated by
Descriptive statistics for baseline characteristics and the outcome STAXI, STAI and BDI) and the PDI diagnosis (presence/absence
measures at each timepoint were calculated. ANOVA and Post-hoc distress sign); the distribution of BC group into no distress
analysis have been used to detect the statistical significance of the sign/distress sign subgroup has been performed by the cut-off > 25:
overall differences in the mentioned variables across the psychological by the range value 13-25  was included subject with no sign of
variables. The data was performed by SPSS program with fixed value α  = < 0.05.
distress; by the range value 26-65 was performed the inclusion of
subjects with sign of distress. The One way ANOVA 2x3 showed
significatively difference (F(3,38)= 6.509; p  >  0.001), and Post-hoc
analysis evidenced the patients with distress sign have higher
Results depression and anger factors (p < 0.001); in opposite, the anxiety
didn’t result a related factor (see Figure 2). Besides, we wanted to
In Table II are reported the raw scores of the sample in the different check the influence of social
emotional tests.
Firstly, we compared the emotional condition of BC group and NC
group to verify the presence of emotional weak conditions measured
in anxiety, anger and depression labes. An One way ANOVA 2x3
showed no significatively difference between examined groups in
anger and anxiety factors; in the depression variable, the BC group
evidenced scoring significantly different than NC group
(F(1,79) = 6.63; p < 0.01) (Post-hoc p < 0.01) showing a more
weakness of BC group than NC group (see Figure 1). Anyway, we
have to highlight that even thought the BC group is resulted having
higher scoring then NC group, the BC patients hadn’t been diagnosed
‘depressed’ because their performance was under pathological value
(cut-off = 13).

Kemudian, kelompok SM dibagi dalam 2 sub kelompok (Young dan

Dewasa) dengan nilai median dari lama rentang tahun. median berusia 44
tahun. Sebuah Salah satu cara ANOVA dilakukan untuk membandingkan
kinerja data Muda dan Dewasa subkelompok dalam tes psikologi. Tidak
ada perbedaan penunjuk telah dibuktikan.
Gambar 1.
Kemudian, kami menguji fitur emosional seluruh Depresi representasi dari kedua SM dan NC kelompok.

193
D. Di Giacomo et al.
FIguRe 2.
Comparison between timing and emotional features in PDI diagnosis.
factors (as marital, maternity, education, occupation) on emotional
condition and/or psychological distress. We applied a MANOVA 2
(groups: BC/NC) x 2 (marital status: married/no married) x 4 (tasks:
PDI, BECK-II, STAXI STAY): results showed no significative
influence; the same finding we get by the maternity factor (mother/no
mother), employment status (worked/no worker); a MANOVA 2x3
(education: lower secondary school; high school, master degree) x 4
to evaluate the educational factor: no significative difference between
BC and NC groups in the emotional performance. Finally, we wanted
to verify if the emotional condition could be influenced by
pharmacological timing, pushing emotional changing on going of the
treatments. We have distributed the BC group by treatment timing:
T0 = post survey and 20 days from diagnosis; T1 = post
chemotherapy and after 6 months from diagnosis; T2  =  ongoing
hormone therapy and 12 months from the diagnosis. The MANOVA 2
(group: distress/no distress sign) x3 (timing: T0, T1, T2) x3 (emotional
tasks: STAXI, STAI, BECK-II) evidenced no significant interaction by
examined variables.
Discussion and Conclusions
The present study is aimed to analyze the emotional distress of breast
cancer sample in terms of depression, anger, anxiety and
psychological distress. In particular, our study has been focused on
the younger sample (range age 35-50 years old) with diagnosis of
breast cancer in early time. Our findings appeared interesting. The
young women with breast cancer seemed resilient and
194
motivated dealing with the illness, and focused on the good
compliance and getting the fast positive outcome. In fact, our sample
showed no signs of mood disorders or psychopathological conditions.
The cancer diagnosis has harsh impact making patients weaker, but
anyway their psychological resilience consents to them to be stronger
and having a stronger feedback with their real clinical condition.
Our results evidenced significant difference only in depression
variable but not in pathological range: the patients have presented
higher and significative scores than healthy women; anyway the
scores have been under cut-off of depression diagnosis. No one of
sample (both pathological and healthy groups) has showed signs of
depression. Those data highlighted the positive personal perspective
of the young patients dealing with the cancer illness. The setting of
psychological support has to be modeled on that proposing
therapeutical strategies oriented to improve mostly their later mental
wellness. The experience, expression and control of anger scores and
the expression of the anxiety scores have highlighted resilient
performance in breast cancer patients not associated a specific social
variables. Moreover, the multivariate analysis on the psychological
tests on timing pharmacological treatments didn’t show difference
between patients and health subjects. Our findings evidenced the role
of psychological resilience of the women dealing with the breast
cancer in the adjustment to the pathological condition: internal factors
seem to play a central role in the psychological resilience, as the
external (social) factors didn’t relieved like main variables influencing
the emotional system of the patients. In fact, our finding evidenced the
absence of sociodemographic influence. We suggest the predictive
variable for better adjustment to the clinical condition is the internal
variable (personality). The personality traits are strengthness to deal
with the disease impact in different timing of pharmacological
treatment. Our finding confirmed the clinical relevance of
psychological resilience in the complex clinical treatments of patients
(surgery and/or pharmacological intervention)  15 16, highlighting the
positive impact confronting the emotional distress and coming back to
normal life. Urcuyo  17 analyzed the breast cancer diagnosis also can
have an overall positive impact women life promoting benefit outcome.
In fact, the tremendous progress in medical path has favored early
interventions, joined to major survival and induced positive life
expectations. Patients can experience positive as well as negative
emotional conditions from breast cancer illness; benefit finding are
supported by resilience impact on patients in the direction of a better
internal psychological change an increased acceptance of the
imperfections in life, renewed appreciation of own social and affective
context.

Afterwards breast cancer diagnosis, benefit finding seem to reflect a
positive, accommodative, and appreciate orientation to life. Our finding
sustains the need to guide the women in the clinical path not only to
deal with in the early time the diagnosis, but also and much more to
reduce the stressful and favor the efficient winning life back. Major
compliance, faster coming back to the normality, controlled impact of
the disease: these 3 mentioned indexes seem efficacy in the lighting
of clinical burden of the patients and a better complex and integrated
clinical intervention in breast cancer illness.
Funding
This study was realized by Italian National Grant ‘Future in Research’
(MIUR – RBFR08A5NE) awared to Dr. D. Di Giacomo.
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